{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:12:44Z","timestamp":1791562364232,"version":"4.3.4"},"reference-count":37,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T00:00:00Z","timestamp":1706659200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Muslims constitute approximately 20% of the world\u2019s population. In South Africa, Muslims constitute just under 2% of the total population. Fasting is one of the mandatory activities of adherents of the Islamic faith, where all healthy adult Muslims abstain from food, drink, and sexual activities between dawn and dusk during the month of Ramadhan. Medical doctors are frequently required to provide advice to their Muslim patients about the safety or other health impacts of this type of fasting. This narrative review provides an overview of research conducted on Muslim populations during the fasting period, with special reference to non-communicable diseases (NCDs) that are prevalent in the Muslim community. In the absence of evidence-based clinical guidelines, this article summarises the latest published research on this topic, providing a resource for clinicians and researchers. This paper provides an evidence summary to clinicians when engaging with their patients who may be engaging in Ramadhan fasting, while also identifying gaps in the body of evidence that could inform future research.<\/jats:p>","DOI":"10.4102\/safp.v66i1.5805","type":"journal-article","created":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T17:47:18Z","timestamp":1706723238000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Ramadhan fasting for people living with chronic illness: A narrative literature review"],"prefix":"10.4102","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5411-9363","authenticated-orcid":false,"given":"Tasleem","family":"Ras","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03p74gp79","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Cape Town"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2606-9125","authenticated-orcid":false,"given":"Rashiqua","family":"Holdman","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03p74gp79","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Cape Town"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3562-4599","authenticated-orcid":false,"given":"Dianne","family":"Matthews","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03p74gp79","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Cape Town"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2024,1,31]]},"reference":[{"key":"ref0","unstructured":"World Population Review. Muslim population by country. [cited 2023 Jul 04]. Available from: https:\/\/worldpopulationreview.com\/country-rankings\/muslim-population-by-country"},{"key":"ref1","unstructured":"United Ulama Council of SA. SA Stats. [cited 2023 Jul 04]. Available from: http:\/\/uucsa.co.za\/index.php\/activities\/110-sa-stats"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Roky R, Houti I, Moussamih S, Qotbi S, Aadil N. Physiological and chronobiological changes during Ramadan intermittent fasting. Ann Nutr Metab. 2004;48(4):296\u2013303. https:\/\/doi.org\/10.1159\/000081076","DOI":"10.1159\/000081076"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Kul S, Sava\u015f E, \u00d6zt\u00fcrk ZA, et al. Does Ramadan fasting alter body weight and blood lipids and fasting blood glucose in a healthy population? A meta-analysis. J Relig Health. 2014;53:929\u2013942. https:\/\/doi.org\/10.1007\/s10943-013-9687-0","DOI":"10.1007\/s10943-013-9687-0"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Akhtar P, Kazmi A, Sharma T, Sharma A. Effects of Ramadan fasting on serum lipid profile. J Fam Med Prim Care. 2020;9(5):2337\u20132341. https:\/\/doi.org\/10.4103\/jfmpc.jfmpc_550_19","DOI":"10.4103\/jfmpc.jfmpc_550_19"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Jahrami H, Trabelsi K, Alhaj OA, Saif Z, Pandi-Perumal SR, BaHammam AS. The impact of Ramadan fasting on the metabolic syndrome severity in relation to ethnicity and sex: Results of a systematic review and meta-analysis. Nutr Metab Cardiovasc Dis. 2022;32(12):2714\u20132729. https:\/\/doi.org\/10.1016\/j.numecd.2022.09.001","DOI":"10.1016\/j.numecd.2022.09.001"},{"key":"ref6","unstructured":"El Arnoaty YM, Johnson WA. Nutritional and biochemical changes during Ramadan fasting. FASEB J. 1991;5:1665."},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Bahijri S, Borai A, Ajabnoor G, et al. Relative metabolic stability, but disrupted circadian cortisol secretion during the fasting month of Ramadan. PLoS One. 2013;8(4):e60917. https:\/\/doi.org\/10.1371\/journal.pone.0060917","DOI":"10.1371\/journal.pone.0060917"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Hassanein M, Afandi B, Ahmedani MY, et al. Diabetes and Ramadan: Practical guidelines 2021. Diabetes Res Clin Pract. 2022;185:109185. https:\/\/doi.org\/10.1016\/j.diabres.2021.109185","DOI":"10.1016\/j.diabres.2021.109185"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Ali S, Davies MJ, Brady EM, et al. Guidelines for managing diabetes in Ramadan. Diabet Med. 2016;33:1315\u20131329. https:\/\/doi.org\/10.1111\/dme.13080","DOI":"10.1111\/dme.13080"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Deeb A, Elbarbary N, Smart CE, et al. ISPAD clinical practice consensus guidelines: Fasting during Ramadan by young people with diabetes. Pediatr Diabetes. 2020;21(1):5\u201317. https:\/\/doi.org\/10.1111\/pedi.12920","DOI":"10.1111\/pedi.12920"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Hassanein M, Abdelgadir E, Bashier A, et al. The role of optimum diabetes care in form of Ramadan focused diabetes education, flash glucose monitoring system and pre-Ramadan dose adjustments in the safety of Ramadan fasting in high risk patients with diabetes. Diabetes Res Clin Pract. 2019;150:288\u2013295. https:\/\/doi.org\/10.1016\/j.diabres.2018.12.013","DOI":"10.1016\/j.diabres.2018.12.013"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Gaborit B, Dutour O, Ronsin O, et al. Ramadan fasting with diabetes: An interview study of inpatients\u2019 and general practitioners\u2019 attitudes in the South of France. Diabetes Metab. 2011;37(5):395\u2013402. https:\/\/doi.org\/10.1016\/j.diabet.2010.12.010","DOI":"10.1016\/j.diabet.2010.12.010"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Aldawi N, Darwiche G, Abusnana S, Elbagir M, Elgzyri T. Initial increase in glucose variability during Ramadan fasting in non-insulin-treated patients with diabetes type 2 using continuous glucose monitoring. Libyan J Med. 2019;14(1):1535747. https:\/\/doi.org\/10.1080\/19932820.2018.1535747","DOI":"10.1080\/19932820.2018.1535747"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Hypertension guideline working group; Seedat YK, Rayner BL, Veriava Y. South African hypertension practice guideline 2014. Cardiovasc J Afr. 2014;25(6):288\u2013294. https:\/\/doi.org\/10.5830\/CVJA-2014-062","DOI":"10.5830\/CVJA-2014-062"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Salim I, Al Suwaidi J, Ghadban W, Alkilani H, Salam AM. Impact of religious Ramadan fasting on cardiovascular disease: A systematic review of the literature. Curr Med Res Opin. 2013;29(4):343\u2013354. https:\/\/doi.org\/10.1185\/03007995.2013.774270","DOI":"10.1185\/03007995.2013.774270"},{"key":"ref16","unstructured":"Alinezhad NM, Salehi M. Effects of Ramadan fasting on blood pressure in hypertensive patients: a systematic review. J Fast Health. 2016;4(1):17\u201321."},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Al-Jafar R, Themeli MZ, Zaman S, et al. Effect of religious fasting in Ramadan on blood pressure: Results from LORANS (London Ramadan Study) and a meta-analysis. J Am Heart Assoc. 2021;10(20):e021560. https:\/\/doi.org\/10.1161\/JAHA.120.021560","DOI":"10.1161\/JAHA.120.021560"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Hammoud S; Kurdi M, Van den Bemt BJF. Impact of fasting on cardiovascular outcomes in patients with hypertension. J Cardiovasc Pharmacol. 2021;78(4):481\u2013495. https:\/\/doi.org\/10.1097\/FJC.0000000000001097","DOI":"10.1097\/FJC.0000000000001097"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Aslan S, Ali RD, Kahraman S, et al. The effect of Ramadan fasting on ambulatory blood pressure in treated hypertensive patients using diuretics. Blood Press Monit. 2020;25(4):195\u2013200. https:\/\/doi.org\/10.1097\/MBP.0000000000000451","DOI":"10.1097\/MBP.0000000000000451"},{"key":"ref20","unstructured":"Bener A, Hamad A, Fares A, Al-Sayed HM, Al-Suwaidi J. Is there any effect of Ramadan fasting on stroke incidence?. Singapore Med J. 2006;47(5):404."},{"key":"ref21","unstructured":"National Institute of Communicable Diseases. National Cancer registry. [cited 2023 Jul 09]. Available from: https:\/\/www.nicd.ac.za\/centres\/national-cancer-registry\/"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Bragazzi NL, Briki W, Khabbache H, et al. Ramadan fasting and patients with cancer: State-of-the-art and future prospects. Front Oncol. 2016;6:27. https:\/\/doi.org\/10.3389\/fonc.2016.00027","DOI":"10.3389\/fonc.2016.00027"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"Lachgar A, Ridai S, Mouafik S, et al. [Ramadan fasting during treatment with external beam radiotherapy]. Bull Cancer. 2022;109(3):331\u2013337. https:\/\/doi.org\/10.1016\/j.bulcan.2021.05.010","DOI":"10.1016\/j.bulcan.2021.05.010"},{"key":"ref24","unstructured":"Islamic Medical Association of South Africa. The medical A-Z of fasting. [cited 2023 Jul 09]. Available from: http:\/\/ima-sa.co.za\/the-medical-a-to-z-of-fasting-in-islam\/"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Murdani A, Edy Rizal W, Pringgodigdo N, Andi A. Kidney function profile before, during, and after Ramadan fasting in healthy elderly: A prospective cohort study. Med J Indonesia. 2022;31(2):115\u2013119. https:\/\/doi.org\/10.13181\/mji.oa.225730","DOI":"10.13181\/mji.oa.225730"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Jack H, Wagner RG, Petersen I, et al. Closing the mental health treatment gap in South Africa: A review of costs and cost-effectiveness. Glob Health Action. 2014;7:23431. https:\/\/doi.org\/10.3402\/gha.v7.23431","DOI":"10.3402\/gha.v7.23431"},{"key":"ref27","unstructured":"Tomlinson M, Grimsrud AT, Stein DJ, Williams DR, Myer L. The epidemiology of major depression in South Africa: Results from the South African stress and health study. S Afr Med J. 2009;99(5):367\u2013373."},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Wang Y, Wu R. The Effect of fasting on human metabolism and psychological health. Dis Markers. 2022;2022:5653739. https:\/\/doi.org\/10.1155\/2022\/5653739","DOI":"10.1155\/2022\/5653739"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Berthelot E, Etchecopar-Etchart D, Thellier D, Lancon C, Boyer L, Fond G. Fasting interventions for stress, anxiety and depressive symptoms: A systematic review and meta-analysis. Nutrients. 2021;13(11):3947. https:\/\/doi.org\/10.3390\/nu13113947","DOI":"10.3390\/nu13113947"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Furqan Z, Awaad R, Kurdyak P, Husain MI, Husain N, Zaheer J. Considerations for clinicians treating Muslim patients with psychiatric disorders during Ramadan. Lancet Psychiatry. 2019;6(7):556\u2013557. https:\/\/doi.org\/10.1016\/S2215-0366(19)30161-0","DOI":"10.1016\/S2215-0366(19)30161-0"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"Heun R. A systematic review on the effect of Ramadan on mental health: Minor effects and no harm in general, but increased risk of relapse in schizophrenia and bipolar disorder. Global Psychiatry. 2018;1(1):7\u201316. https:\/\/doi.org\/10.2478\/gp-2018-0002","DOI":"10.2478\/gp-2018-0002"},{"key":"ref32","unstructured":"Statistics South Africa. Marginalised Groups Series VI: The Social Profile of older persons, 2017\u20132021. [cited 2023 Jul 08]. Available from: https:\/\/www.statssa.gov.za\/publications\/03-19-08\/03-19-082021.pdf"},{"key":"ref33","unstructured":"Boss GR, Seegmiller JE. Age-related physiological changes and their clinical significance. West J Med. 1981;135(6):434\u2013440."},{"key":"ref34","doi-asserted-by":"crossref","unstructured":"Baccouche H, Hellara I, Khochtali I, et al. Ramadan fasting effects on metabolic parameters in elderly persons with cardiovascular risk factors. J Aging Res Clin Pract. 2014;3:200\u2013205. https:\/\/doi.org\/10.14283\/jarcp.2014.35","DOI":"10.14283\/jarcp.2014.35"},{"key":"ref35","unstructured":"Ghazi HA, Boughdady AM, Elsayed EB. Effect of Ramadan fasting on physical and mental health of elderly people. World J Nurs Sci. 2018;4(3):56\u201365."},{"key":"ref36","doi-asserted-by":"crossref","unstructured":"Laatar R, Borji R, Baccouch R, Zahaf F, Rebai H, Sahli S. Effects of Ramadan fasting on postural balance and attentional capacities in elderly people. 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